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Clinicians rise to the challenge, improve MIPS scores despite increased requirements

More participants avoided a penalty in year two of Medicare’s Quality Payment Program (QPP) despite tougher rules, according to an infographic released by CMS, July 11.
More than 97% of the 916,058 participants scored above the performance threshold in the 2018 performance year. CMS increased the threshold to 15 overall points from 3 the previous year.
Not only that, participants managed the higher score despite the fact that CMS counted the Cost category for the first time last year (10% of the overall score).
Fewer than 2% of participants ended up paying a penalty this year as a result of their 2018 performance, compared with almost 5% who were penalized last year based on their 2017 score.
The majority of clinicians (559,230) are still participating through the merit-based incentive payment system (MIPS), though the number participating through a MIPS alternative payment model (APM) rose to 356,828 in 2018 from 341,220 the previous year.
At the same time, the number of clinicians who achieved the status of qualifying APM participants by meeting certain criteria that allowed them to receive a 5% bonus and get excluded from MIPS increased substantially between 2017 and 2018 — from 99,076 to 183,306.
In a blog post about the results, CMS director Seema Verma acknowledged that “some clinicians in small practices are still receiving negative payment adjustments.”
The agency adjusted the participation thresholds for 2018 so a large portion of clinicians in small practices were not required to participate in QPP, but many of them did anyway. Nearly 85% of small practices were able to get a positive payment adjustment based on 2018 participation, compared with almost 74% the previous year, Verma said.
Those who participated through an APM achieved a positive adjustment at a rate of nearly 100%, by comparison.
Expect ongoing tweaking of the program in the coming years, as CMS attempts to address criticism that QPP is overly complex, according to Verma.
In the meantime, CMS has helpfully added some of clinicians’ 2017 QPP results to its Physician Compare site, Verma stated. Depending on the measure type, the agency displays the measures results as star ratings or percent performance scores.
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